§ 21C — Point of sale charge for prescription drug; limit on amount of cost-sharing payment

Massachusetts § 21C

• Jurisdiction: Massachusetts
• Part I: ADMINISTRATION OF THE GOVERNMENT
• Title XV: REGULATION OF TRADE
• Ch. 94C: CONTROLLED SUBSTANCES ACT

Text

[ Text of section added by 2024, 342, Sec. 27 effective April 8, 2025.]Section 21C. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:"Cost-sharing'', an amount owed by an individual under the terms of the individual's health benefit plan."Health benefit plan'', as defined in section 1 of chapter 176O."Pharmacy benefit manager'', as defined in section 1 of chapter 176Y."Pharmacy retail price'', the amount an individual would pay for a prescription drug at a pharmacy if the individual purchased that prescription drug at that pharmacy without using a health benefit plan or any other prescription medication benefit or discount.(b) At the point of sale, a pharmacy shall charge an individual for a prescription drug the lesser of: (i) the applicable cost-sharing amount; or (ii) the pharmacy retail price.(c) A health benefit plan or carrier shall not require an insured to make a cost-sharing payment for a prescription drug in an amount greater than that charged pursuant to subsection (b).(d) No contractual obligation between a pharmacy benefit manager and a pharmacist shall prohibit a pharmacist from complying with this section.